Abigail,a newly born, in the corner of the Chatinkha nursery in Queen Elizabeth Central Hospital in Blantyre, Malawi, Lilian Matchaya her mother is expressing milk.she’s lying in a wooden cot with a UV light overhead keeping her at the right temperature. Her head wrapped in a bandage, Abigail has a plastic feeding tube going into her nose.
Matchaya, 38, inserts a syringe of breast milk into the tube, and it travels slowly down the translucent pipe. The sounds of infants crying, machines beeping and nurses pushing trolleys fill the ward.
Abigail was born prematurely at seven months and weighed just 1.8 kilograms (3 pounds) at birth, little more than a bag of flour. She needed an injection of aminophylline, which dilates the lung’s cells, to help her breathe, and the day after her birth, nurses found her passed out with blood in her stool.
Babies, especially those born prematurely, are especially vulnerable to infection, as their immune systems haven’t developed properly. Doctors suspected that Abigail had sepsis, a serious and potentially fatal condition in which bacteria get into the bloodstream. In response, the body’s immune system goes into overdrive, and organs begin to shut down.
Abigail was given two antibiotics, penicillin and gentamicin, a combination meant to kill a wide range of bacteria. The drugs didn’t seem to work, and she was soon given ceftriaxone and metronidazole, but there was still no improvement.
Her medical notes state that she then became floppy and passed out once more.
Lab results revealed that she was infected with a drug-resistant form of Klebsiella. The bacteria were resistant to most of the drugs Abigail had been given, meaning the medications were not working to kill her infection.
For four days, she had been given ineffective drugs.
For every hour that a baby in septic shock is given ineffective drugs, the chance of survival decreases by 7.6%, one study found. Dr. Kondwani Kawaza, a neonatologist at the Chatinkha nursery, said that even if the baby doesn’t die, sepsis can cause disabling complications such as brain damage, meningitis and impairment to vital organs like the kidneys and the liver.
Doctors at the hospital also face another problem: The antibiotics they needed to treat Abigail’s superbug are expensive and not part of Malawi’s standard drug regimen, meaning they’re not always available in the hospital.
On this occasion, Abigail was lucky: The pharmacy had one of the drugs they needed, amikacin, which can be given for only short periods, as it can trigger deafness as well as kidney and nerve damage.
Abigail was promptly given amikacin, after which her family faced a waiting game.
“The first thing I do when I wake up daily is to pray for my baby to get well. Then I check on her with the hope that she will be OK,” said Matchaya, a soft-voiced housewife, through an interpreter. She lives with her husband, a teacher, and three sons in Nancholi, on the outskirts of Blantyre.
According to Kawaza, 20% to 40% of infections his team diagnoses are now resistant to antibiotics. The proportion was a lot lower five years ago, he said.
“Four patients grew Klebsiella in this ward alone in a single week, where in the past, we would say it would be for the whole month,” he said. “It’s becoming a bigger and bigger problem.”